临床儿科杂志 ›› 2021, Vol. 39 ›› Issue (8): 600-.doi: 10.3969/j.issn.1000-3606.2021.08.010

• 综合报道 • 上一篇    下一篇

儿童急性淋巴细胞白血病早期治疗反应对预后的预测价值

李红, 邵静波, 朱嘉莳, 张娜, 陈凯, 王真, 邹冰, 夏敏, 蒋慧   

  1. 上海交通大学附属儿童医院血液肿瘤科（上海 200040）
  • 发布日期:2021-08-17
  • 通讯作者: 蒋慧 电子信箱：jhui 0111 @ 126 .com
  • 基金资助:
    上海市科学技术委员会课题（No. 18 ZR 1431200 )

Value of early treatment response to assess prognosis of children with acute lymphoblastic leukemia

LI Hong, SHAO Jingbo, ZHU Jiashi, ZHANG Na, CHEN Kai, WANG Zhen, ZOU Bing, XIA Min, JIANG Hui   

  1. Department of Hematology and Oncology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, Shanghai 200040, China
  • Published:2021-08-17

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摘要： 目的 探讨CCCG- 2015方案治疗儿童急性淋巴细胞白血病（ALL）早期治疗反应评估对预后的预测价值。 方法 回顾2015年4月至2019年12月以CCCG- 2015方案规范治疗的220例初诊ALL患儿的临床资料，分析诱导治疗第 19、46天骨髓细胞学及微小残留病（MRD）监测评估早期治疗反应。结果 220例患儿中，男128例、女92例；中位年龄5.1 岁；中位随访时间45个月。诱导缓解率97 . 7 %，长期生存率94 . 6 %，病死率5.4%，复发率6.8%。5年无事件生存（EFS） 率（87 . 5±2.6）%，5年总生存（OS）率（92 . 7±2.2）%，5年累积复发率（9.4±2.4）%，中位复发时间为32（9 ~ 34）个月。 低、中、高危组5年EFS差异有统计学意义（P<0.05）；MRD阳性组中，MRD 0 . 01 %~ 0 . 099 %、0 . 1 %~ 0 . 99 %、≥1 %的5年EFS率差异有统计学意义（P<0.001）。COX回归分析发现，第19天 MRD≥1 % （HR=7.04，95%CI：2.84~17.46）和第46天MRD≥0.01%（HR=1.67，95%CI：1.17~2.37）是影响EFS的独立危险因素。 结论 诱导治疗第19天MRD

关键词: 急性淋巴细胞白血病； 无事件生存； 预后； 儿童

Abstract: Objective To retrospectively analyze the value of early treatment response to assess prognosis of children with acute lymphoblastic leukemia (ALL). Methods Two hundred and twenty newly diagnosed ALL patients from April 2015 to December 2019 were included in this study. CCCG-ALL 2015 regime was given to these patients. Bone marrow cytology and minimal residual disease were detected to evaluate the early treatment response on the Day 19 and Day 46 after induction treatment. Results A total of 92 females and 128 males were enrolled in this study. The median age was 5 . 1 years, and the median follow-up time was 45 months. The induced remission rate was 97 . 7 %, the long-term survival rate was 94 . 6 %, the mortality rate was 5 . 4 %, and the recurrence rate was 6 . 8 %. The 5 -year cumulative recurrence rate was ( 9 . 4 ± 2 . 4 )%, and the median recurrence time was 32 months. The 5 -year EFS was ( 87 . 5 ± 2 . 6 )%, and the 5 -year OS was ( 92 . 7 ± 2 . 2 )%. The difference among three groups (low-risk group, medium risk group and high-risk group) was statistically significant (P< 0 . 05 ). The 5-year EFS rate of MRD-negative and positive groups on day 19 of induced therapy were (94.4±3.5)% and (82.5±3.9)%, respectively, the differences were statistically significant (P< 0 . 05 ). In the MRD positive group, differences among the 5 -year EFS rate of MRD 0 . 01 %~ 0 . 099 %, 0 . 1 %~ 0 . 99 %, and ≥1 % groups were ( 93 . 5 ±3 . 8 )%、( 80 . 9 ± 7 . 1 )% and ( 64 . 1 ± 10 . 3 )% respectively, which showed statistical significance (P<0.001). Multivariate analysis showed that MRD≥1% on day 19 (HR= 7 . 04 , 95 %CI: 2 . 84 - 17 . 46 ) and MRD≥ 0 . 01 % on day 46 (HR=1.67, 95%CI: 1 . 17 - 2 . 37 ) were independent risk factors for the prognosis of EFS. Conclusion The overall efficacy of acute lymphoblastic leukemia in children was satisfied, with high induction remission rate, and the recurrence rate of the children with D 19 MRD< 0 . 01 % was low. MRD≥ 1 % on Day 19 and MRD≥ 0 . 01 % on Day 46 are poor factors affecting the prognosis of childhood ALL.

Key words: acute lymphoblastic leukemia; event-free survival; prognosis; child

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